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What would the equivalent dosage of a compounded estradiol cream/gel (NOT Bi-est or Tri-est) be to 2 mg Estrace or a .1 estradiol patch?

My doctor and the pharmacists I've spoken to are only knowledgable about Bi-Est and Tri-est, not pure estradiol cream/gel. I've gotten so many conflicting responses, and I'm hoping someone here will be able to guide me in the right direction!

Sorry to bother again -- but does anyone have any idea about dosage conversion?

I've been told everything from 0.75, to 1, to 2, to 2.5 mg of a straight-estradiol cream/gel is equivalent to 2 mg of Estrace (or a 0.1 mg patch). Isn't there a standard conversion chart that different pharmacies follow? .75 - 2.5 mg is quite an extreme variation!!

I'm not on any HRT right now (recently had to end a very brief and unsuccessful fling with FemRing) and feeling lousy as a result, yet I don't feel comfortable going ahead and trying compounded hormones until I can at least be sure the pharmacy is going to get my dosage right! So currently, I'm stuck doing nothing.

I would immensely appreciate a response from someone who could provide some insight. Thank you so much!

I wish I could answer your question but I have zero experience with converting doses.

There are no guarantees the compounding pharmacy will get your doseage right on the first try any more than there would be for a doctor to get the doseage right the first time on any other type of HRT. I do believe someone with lots of knowledge about HRT is more apt to get it right than someone with little to no knowledge. My compounding pharmacist didn't get mine right on the first try but did on the second. There's just not a way to accurately predict exactly how we'll do on any HRT. By working closely as a team it's possible to tweak it and get it right. It takes time and patience, trial and error.

Have you had your levels tested? Did you have to fill out any sort of questionnaire before a consultation? The more information they have about you the better the chance is that you'll find your hormone balance.

I've been seeing a "traditional" gynecologist who has tested my hormones countless times over the past several years, and regardless of the form of HRT (BCPs, Estrace, patches, FemRing), my serum estradiol levels have always remained under 20. The one exception was the Esclim patch, but I developed hives from using it.

Compounded hormones are my last resort before going to injections. I haven't done a "consultation" with a compounding pharmacy; my gyn was just going to fax in a prescription for an estradiol cream/gel equivalent to the .1 Esclim patch (I need higher doses because I'm still in my twenties and have severe osteopenia.)

I know that I will probably have to tweak my dose higher or lower after starting the cream depending on my symptoms, but I'm just trying to find out what the actual equivalent dose is to start on.

Hi, I hope I can help... I use the conversions given at the back of the Women's Encyclopedia of Natural Medicine by Tori Hudson, ND. My internist uses it as well, that's how I learned about it.

2mg of Estrace (oral) is roughly equivalent to a 0.1mg/day estradiol patch (any brand). Roughly is because when you take HRT's orally, how much makes it to your tissues depends on how efficient your liver is at clearing it. As for the estradiol cream, 0.1mg per day is 0.1mg per day as long as it's transdermal, so that would also be equivalent to the 0.1mg/day patch.

The issue is knowing how much cream to use to get 0.1mg per day. That depends on what strength the cream is. If the compounding pharmacist makes up a 0.1mg per gram of cream mixture, then you'd use one gram of cream (about 1cc) per day to get the same as an 0.1mg/day patch.

Now I'm more confused than ever! 0.1 mg is so much lower than anything I've been told thus far (though one pharmacist responded with 0.1 mg patch = 1.0 mg cream).

I thought when taking Bi-est, for example, the average dose is 2.5 mg/day (equivalent to 1 mg Estrace = .05 mg patch = .625 mg Premarin), and 0.5 mg (20%) of Bi-est is estradiol? So in a 0.1 mg estradiol cream, I would only be getting 1/5 of the typical estradiol dose, and that's even without any estriol -- but the 0.1 patch is twice the commonly prescribed dose.

I don't mean to sound as if I'm doubting you at all, but I'm just so lost amidst all the incredibly different answers (even among different pharmacists at the same pharmacy!). I recently spoke w/Women's International Pharmacy, for example, and they said for an estradiol-only cream I would use the corresponding oral Estrace dosage (ie, 2 mg/day oral estradiol = 2 mg/day estradiol cream). But 2 mg is 20 times 0.1 mg, if 0.1 is indeed the correct dosage of cream I should be on! This is starting to actually frighten me a bit, to think I could potentially overdose *that* much.

Am I over-thinking this? Should I just eenie-meenie-minee-mo a compounding pharmacist, go ahead with the 2 mg dosage, and hope I don't turn into a giant walking ovary?

Well... I understand your frustration. Here's another question to add to the confusion : if you just want estradiol cream, why not just have your DR prescribe Estrace cream? It's available at a regular pharmacy. Dr. Hudson states that Estrace cream contains 0.1mg of estradiol per gram of cream. That's the same as what I suggested... 0.1mg of compounded estradiol per gram of cream.

It's true that a typical bi-est dosage might be 2.5mg per day. However, that's an oral dosage for bi-est capsules. When you ingest them, they first pass through your digestive system, and about 95% of the estrogen is broken down in the liver into other side products that don't help with your symptoms. You only actually get the benefit from about 5%, or 0.125mg, of estrogens, and that's not all estradiol but a mixture of estradiol and estriol, so it's roughly equivalent to 0.1mg of estradiol in transdermal form.

Ultimately you and your DR need to decide together what would be best for you to try. Given that Estrace cream is 0.1mg per gram, though, if you're wanting to go with a compounded estradiol cream I'd try that same strength, not 20 times higher, that's just plain scary imho.